Comment on: Unique case of midbrain tuberculoma presenting as isolated inferior rectus palsy with nystagmus

Pandey, Pramod Kumar; Joon, Annu; Bhattacharyya, Mainak; Kishore, Divya; Yadav, Monika; Kumar, Sumit

doi:10.4103/ijo.ijo_654_18

Cited by 1 publication

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“…Spoor TC et al [ 5 ] found myasthenia gravis presenting as an isolated IRM palsy of acute onset, Almog Y et al [ 6 ] detected myasthenia gravis may affect any of the six extra-ocular muscles, six (20%) isolated inferior rectus was affected in his 30 patients with a clinical diagnosis of myasthenia gravis. A variety of presumed etiologies for isolated IRM palsy had been reported in previous literature, including congenital [ 1 , 4 ], cerebral infarction (vascular) [ 3 , 4 , 7 , 8 ], trauma (especially orbital blow-out fracture) [ 1 – 4 , 9 , 10 ], infection (brain tuberculosis) [ 3 , 11 ], effects associated with surgeries for cataracts [ 12 , 13 ], strabismus [ 2 ] and retinal detachment [ 14 ], multiple sclerosis [ 15 ], midbrain cavernous hemangioma [ 16 ], myasthenia gravis [ 1 , 3 , 5 , 6 ], thyroidal ophthalmopathy [ 3 ] and idiopathic [ 1 ]. Variations in patient populations may be responsible for these differences in reported etiologies.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and surgical outcomes of isolated inferior rectus palsy

Zhu

Yan

2021

BMC Ophthalmol

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Aim As isolated inferior rectus muscle (IRM) palsy represents a rare clinical entity, very limited information is available on this condition. The aim of this report was to elucidate the etiology, clinical characteristics and surgical outcomes of isolated IRM palsy. Methods Isolated IRM palsy cases who underwent surgical treatments at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China over the period from January 2008 to June 2019 were reviewed retrospectively. Data evaluated from these cases included their etiology, ocular alignment, ocular motility, surgical procedures and surgical outcomes. Results A total of 61 patients (40 males, 21 females) were included in this review. Their mean ± SD age was 27.21 ± 16.03 years (range: 2 to 73 years). In these cases, 32 (52.5%) involved traumatic injury, 28 (45.9%) congenital hypoplasia or absence of inferior rectus and 1 (1.6%) with thyroid ophthalmopathy. The right eye was affected in 33 patients (54.1%), the left in 24 patients (39.3%), and both eyes in 4 patients (6.6%). The main clinical presentations consisted of hypertropia of the affected eye, motility limitation in abduction and depression and incyclotropia. After treatment consisting of various surgical approaches, including muscle repair or resection of the affected inferior rectus, recession of ipsilateral superior rectus, elongation of contralateral superior oblique and partial transposition of the horizontal rectus, the isolated IRM palsy was rectified in 49 patients (80.4%) with one surgery, while 11 cases (18.0%) required two surgeries and 1 case (1.6%) needed three surgeries. Finally, 52 patients (85.2%) showed a complete recovery, 6 (9.9%) improved and 3 (4.9%) experienced a surgical failure. Conclusion The main etiologies of isolated IRM palsy involved traumatic injury and developmental events. Overall, surgical outcomes of the various approaches employed were quite effective.

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